Aim To audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions. Method Between October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted. The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information. Pharmacist interventions requiring further action were recorded. Results Drugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers. 25 patients were identified as having adherence issues. Only 35/232 (15%) prescriptions matched identically. Conclusions This audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs. A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.
The performance of 14 commercial jet nebulisers has been assessed; Unineb, Suremist (Unimed (UK) Ltd), Micro-Cirrus (Intersurgical Ltd), Pulmo-Neb (DeVilbiss Health Care UK Ltd), Side-Stream (Medic-Aid Ltd), Micro-Neb III (Lifecare Ltd), RespirGard (Marquest Medical Products Inc), Aeromist, Venticaire (S and W Vickers Ltd), Up-Draft II, Ava-Neb, Up-Draft (Hudson Respiratory Care Inc), Bennett/Twin, Raindrop (Puritan-Bennett Corporation). The units were operated with a high flow compressor (Maxi III, Medix Ltd) at 101/min. Performance was assessed by measuring the fraction of the initial mass of drug released as an aerosol and nebulisation time for initial drug volume of 2-6mls, and the mass median diameter and mass fraction of the aerosol in particles < 5.17 microns diameter. The Side-Stream nebuliser gave the best performance, although incorporation of a filter to trap exhaled antibiotic may prove difficult. The Micro-Cirrus generated a particularly fine aerosol. The Raindrop nebuliser performed well, while the Up-Draft II nebulised efficiently but was associated with extended nebulisation times which may limit its utility.
The benefits of exercise for people with life-limiting conditions are widely recognised. Woodlands Hospice runs a weekly exercise group which is well attended. Feedback is positive and the environment provides more than simply physical benefits. It has become a safe place that instils positivity and humour where patients can share feelings and coping strategies, gain support and strength from their peers and staff, ask for help whether physical, emotional or spiritual and where they can just 'be'.
Aim
To further develop this group to enhance the experience for patients. Specifically: Music.To introduce music in the form of a personal group playlist where all patients are involved in sharing a song and a reason for its choice. This music is played during the group and made available to take home. Tai Chi. To teach simple chair based Tai Chi to be practised at the end of each session to promote a calm and contemplative atmosphere. Palliative Outcome Scale (POS). Using this recognised tool on a monthly basis helps patients to discuss any new concerns, allows staff to signpost patients appropriately and streamlines outcomes throughout the hospice.
Methods
Literature review on clinical benefits of Music therapy and Tai Chi Consultation with group members Practise Tai Chi sessions Multidisciplinary consultation regarding introduction of POS.
Results
MusicA feeling of ownership and camaraderie promoting discussion ranging from shared memories to the spiritual needs of the present Tai ChiThis new skill has facilitated relaxation, breathing control and aided sleep POSIts use has identified a gap in care when patients are not accessing other hospice services and ensured their needs are met.
Conclusion
The exercise group has proved to be a good leveller with patients feeling confident to share experiences whilst gaining physical and emotional strength.
The evaporative losses of solvent (water) from a commercial jet nebuliser (Unineb, Unimed Ltd) were estimated and found to be approximately 14% of total nebuliser output. A simple analysis of the nebulisation process then enabled the amount of the drug colomycin released as potentially respirable aerosol to be predicted from measurements of the total nebulisation time. Good agreement was found between the predicted (P) and measured (M) values such that P = 1.07 M (r2 = 0.98). The analysis also indicates that the proportion of the drug released as aerosol will increase as nebulisation proceeds provided nebuliser output is continuous and that for a given initial mass of drug a larger amount of drug is released as an aerosol if the volume of administration used in the nebuliser is as large as possible.
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